Provider Demographics
NPI:1770138620
Name:LOUIE, VICTORIA RENAE MICHIKO (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:RENAE MICHIKO
Last Name:LOUIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41268 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4823
Mailing Address - Country:US
Mailing Address - Phone:510-656-7778
Mailing Address - Fax:
Practice Address - Street 1:41268 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4823
Practice Address - Country:US
Practice Address - Phone:510-656-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1039381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice